World AIDS Day 2004: “Not Aware” Is Not an Answer

By Melody Barnes and Shira Saperstein
Posted on December 1, 2004, 9:00 am

During the October debate between vice presidential candidates Dick Cheney and John Edwards, moderator Gwen Ifill asked a question that – surprisingly — was not about Iraq, terrorism, tax cuts or the economy. She said:

"I want to talk to you about AIDS, and not about AIDS in China or Africa, but AIDS right here in this country, where black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their [white] counterparts. What should the government’s role be in helping to end the growth of this epidemic?"

Neither candidate was able to answer this question. Vice President Cheney admitted that he was "not aware" of this fact, and shifted quickly to praising The President’s Emergency Plan for AIDS Relief (PEPFAR), which provides funds for care, treatment and prevention of HIV/AIDS in Africa, Asia and the Caribbean. Senator Edwards criticized PEPFAR for being inadequately funded, and then shifted his attention to lack of health insurance in the U.S.; apart from the latter, he made no attempt to address the specific needs of African American women.

Given the persistent failure of leadership on this issue, perhaps it is not surprising that these two men failed to address what has become a persistent problem in the United States — and in the world – the terrible health disparities between the "haves" and "have nots," disparities that too often cluster along ethnic and/or racial lines. Nowhere is this more apparent than in the world of HIV/AIDS.

Since 1981, when AIDS was first documented in the United States, more than 500,000 Americans have died from the disease. Almost a million others are now estimated to be living with the AIDS virus, and every year thousands more are newly infected – 44,000 new infections this year alone.

More than half of these new infections are occurring among African Americans, despite the fact that they make up only 12 percent of the population. Among women, the racial disparities are even greater. More than two-thirds – 72 percent — of new infections among women occur among African Americans. There are now 23 black women with AIDS for every one white woman, and even among those with AIDS, black women have poorer survival rates. HIV/AIDS is now the leading cause of death among African-American women ages 25-34.

Among teenagers, the statistics are equally bleak. At least half of all new HIV infections are estimated to occur among those under the age of 25, with adolescent girls representing more than half that number. African Americans girls represent 61 percent of new AIDS cases among 13 to19-year-olds.

At this point, we do not truly understand all of the reasons for these health disparities, although disproportionately high rates of poverty and low rates of access to health care are certainly on the list. So, too, is the fact that public funding – for prevention, treatment and care – has not kept pace with the epidemic nor been reallocated appropriately to meet current needs and demographic changes. To the contrary, while most African American women are infected with HIV through heterosexual sex, funding continues to increase for unproven abstinence-only programs rather than for comprehensive and culturally appropriate reproductive health programs that provide condoms and counseling on safe sexual behavior. Despite rising demand for treatment, budget cuts have resulted in long waiting lists for access to AIDS Drug Assistance Programs (ADAP) in almost every state. This has left thousands of HIV-positive Americans unable to secure the drugs they need to save their lives. An estimated half a million Americans currently living with HIV are not getting medical care.

Today is World AIDS Day, a time when we are called to remember the 20 million people around the world who have died from HIV/AIDS, dedicate ourselves to reaching out and caring for the 39.4 million currently living with the virus, and renew our commitment to preventing the further spread of this modern-day plague. As we do all of this, it is too easy to act as if HIV/AIDS is a problem that takes place "over there," in Sub-Saharan Africa, South Asia, Eastern Europe. It is too common to think about this epidemic only in terms of the disastrous consequences for the lives, families, communities, whole economies in other parts of the world and to forget that AIDS is still a crisis here in the United States.

But it is a crisis, and in the same way that national leaders can rattle off economic statistics, they should be knowledgeable about the effect this virus is having on the country and the steps we must take to address it. Policy makers should commit themselves to ensuring that every American has access to evidence-based information about HIV/AIDS and to appropriate prevention, testing and treatment services. They should support – with adequate funding — comprehensive sexuality education for young people; provision of the full range of reproductive health services, including treatment of sexually transmitted diseases; clean needles for addicts; and expanded research to develop both microbicides and an AIDS vaccine.

Almost 90,000 African American women in America are suffering from HIV/AIDS and millions more are at risk. We need to face and address this crisis, and "I was not aware" is not an acceptable answer.

Melody Barnes is a senior fellow at the Center for American Progress. Shira Saperstein is deputy director of the Moriah Fund and a visiting fellow at the Center for American Progress.